At times, in medicine, you feel you are inside a colossal and impossibly complex machine whose gears will turn for you only according to their own arbitrary rhythm. The notion that human caring, the effort to do better for people, might make a difference can seem hopelessly naive. But it isn't.

Man is fallible, but maybe men are less so.

What is the alternative to understanding the complexity of the world?

We've created a multitrillion-dollar edifice for dispensing the medical equivalent of lottery tickets - and have only the rudiments of a system to prepare patients for the near certainty that those tickets will not win. Hope is not a plan, but hope is our plan.

The definition of what it means to be dying has changed radically. We are able to extend people's lives considerably, including sometimes, good days.

If the conversation people think is coming is the 'death panel' conversation, that's a total failure.

I chose surgery because I thought that perhaps this would make me more like the kind of person I wanted to be.